title: Severe parainfluenza pneumonia in a case of transient hypogammalobulinemia of infancy.
abstract: Human parainfluenza viruses (HPIVs) infection, largely known to cause self-limiting bronchiolitis and pneumonia in immune competent patients, can lead to severe to fatal pulmonary disease in immune disorders, such as primary or acquired-immune deficiencies. We report the case of a 1-year-old child who developed an acute respiratory distress syndrome. Because of a progressive respiratory failure unresponsive to conventional treatment extracorporeal membrane oxygenation (ECMO) was rapidly started. HPIV-3 infection was diagnosed on the rhinopharyngeal fluid and immunological examinations revealed a hypogammaglobulinemia. A combination therapy with ribavirin, intravenous immunoglobulin (IVIG) and steroid under ECMO support was started with considerable improvement. Subsequent analysis and more specific immunological assessment resulted normal confirming the diagnosis of transient hypogammaglobulinemia of infancy (THI). This case highlights the importance of prompt therapy with early ECMO support in combination with ribavirin, IVIG and steroids in patients affected by severe HPIV-3 pneumonia and THI.
authors.affiliation: University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cotugno
authors.forename: Emma Concetta
authors.initials: EC
authors.lastname: Manno
authors.forename: Francesca
authors.initials: F
authors.lastname: Stoppa
authors.forename: Serena
authors.initials: S
authors.lastname: Sinibaldi
authors.forename: Claudia
authors.initials: C
authors.lastname: Saffirio
authors.forename: Parizia
authors.initials: P
authors.lastname: D'Argenio
authors.forename: Marco
authors.initials: M
authors.lastname: Marano
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Nardo
authors.forename: Paolo
authors.initials: P
authors.lastname: Palma
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000361:Agammaglobulinemia / Q000150:complications / Q000628:therapy*; D000998:Antiviral Agents / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D018184:Paramyxoviridae Infections / Q000150:complications / Q000628:therapy*; D011024:Pneumonia, Viral / Q000150:complications / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D012254:Ribavirin